Focus on outcomes will advance Army health care, surgeon general says

The Army should adopt the combat medicine practices used in Afghanistan and Iraq and shift its medical model away from one focused on costly processes to one based on health outcomes, its surgeon general said.

The Army practices "effects-based" medicine in Afghanistan and Iraq, which includes investing in such services as an aero-medical evacuation system that can transfer a soldier from the battlefield to a stateside hospital in 24 hours, said Lt. Gen. Eric Schoomaker. The procedure has boosted survival rates for wounded soldiers to about 95 percent as compared with a 70 percent survival rate for wounded soldiers in the Vietnam War.

The Air Force has evacuated 40,000 military personnel from those countries in the past five years on airborne intensive care units "and has never lost a patient" due to the level of care provided on these flights, said Schoomaker, who spoke on March 27 at the Defense Health Care Information Technology Conference at Georgetown University.

The Defense Department has asked for a $23.6 billion health care budget for fiscal 2009, and Schoomaker said an emphasis on health outcomes could help the Army cut its escalating medical budget, or at least stabilize it.

Improvements are still needed in health care technology on the battlefield, he added. While Defense has deployed a worldwide electronic health records system, using it in combat zones is difficult because the systems on battlefields don't have enough bandwidth to access files quickly, Schoomaker said. Medical units in Afghanistan and Iraq struggle to obtain the bandwidth they need from operational units, he noted. When it comes to fielding medical information systems throughout the Army, Schoomaker said there must be a careful balance between innovation and standardization, with an emphasis on the latter.

Asked what key medical IT he would like to see fielded to combat units, Schoomaker pulled out a digital dog tag he wears on a chain around his neck and said, "This." The digital dog tag contains all of a soldier's personal information that clinical staff can download into a handheld computer carried by a combat medic. But the tags, first tested by Defense in 1999, are still in the beta stage and not ready to be deployed.

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